Fellow women’s history blogger, Historiann, has had a couple of recent posts on C-sections on her blog. Since those who read Knitting Clio may or may not read this one as well, I’m bringing the discussion over here. Also, I know some of you are members of the Women in the History of Medicine group within AAHM so are well-positioned to offer comments. Historiann’s first brief post on the subject was in response to a report regarding women who had C-sections being denied insurance coverage. I pointed out that the enormous rise in C-sections over the past half-century has really not improved maternal/child health and is really more a product of malpractice litigation and physician convenience than it is medical science. I also pointed to an entry on Our Bodies, Our Blog about the controversy over whether to allow women to deliver vaginally if they had a C-section during a previous delivery. I felt that Historiann was being unfair to OBOS by suggesting that they, as well as other feminist health activists, have “fetishized” natural childbirth while condemning C-sections. I pointed out that OBOS was among the first were among the first to argue that the benefits of C-sections and other birth interventions were overstated at best, and the risks underreported. Sure, not every woman can deliver vaginally, but the risks of infection during C-section (as with any surgery) are not insignificant.
OBOS’ policy statements are consistent with those in Reproductive Health Reality Check and the World Health Organization. Both point out that the United States has the highest percentage of C-sections (nearly 1/3 of all births), yet the worst maternal and infant mortality and morbidity rates in the developed world.
After going back and re-reading OBOS at my suggestion, Historiann wrote another post yesterday, stating that OBOS was more balanced on the issue than she previously thought, but she still thinks their position on anesthesia and pain medication during childbirth is too “ideological.”
I continued to stick up for OBOS, stating that historically and today, the Boston Women’s Health Collective has sought to empower women by providing them with comprehensive information about the pros and cons of various medical procedures and technologies. This was pretty important in an era when doctors — nearly all (93%) of whom were male, even in ob/gyn — were extremely paternalistic and told women (and men) to follow orders for their own good.
Scientific consensus on particular procedures changes over time as well, and OBOS reflects that as well in it periodic updates. I’m not a historian of anesthesiology but I think that warning women of the possible complications of anesthesia for a fetus, however rare, is in keeping with sound medical practice and informed consent. The position of OBOS on anesthesia during delivery has changed with new evidence. Now, the editors of OBOS favor use of nitrous oxide during delivery.
Also, just want to remind you all of Wendy Kline’s article, “Please Put this in Your Book: Readers Respond to Our Bodies Ourselves,” in Bulletin of the History of Medicine, 2005, 79: 81–110. Kline reminds us that the motto of the Boston Women’s Health Book Collective was “knowledge is power,” and by responding to the editors of OBOS, these ordinary women helped shape the feminist health movement — something women continue to do through the blog.